Two senators are demanding records from the three largest Medicare Advantage insurers over their use of AI and prior authorization to deny post-acute care to seniors. In July 14 letters to UnitedHealthcare, Humana and CVS Health, Sens. Richard Blumenthal, D-Conn.,…
Medicare Advantage
Two more Medicare Advantage insurers are suing CMS over their 2026 star ratings, arguing the agency did not go far enough when it adjusted the ratings following a major court loss to Clover Health earlier this year. SCAN Health Plan…
A federal appeals court has ruled against Alignment Healthcare in its challenge to how CMS calculated the company’s 2025 Medicare Advantage star ratings, upholding a lower court’s decision that mostly sided with the agency. The July 14 ruling caps a…
Nearly 97% of UnitedHealth’s in-home Medicare Advantage diagnoses were supported by a patient’s medical record in 2025, according to a review commissioned by the company. The findings are the latest in UnitedHealth’s efforts to defend HouseCalls, the in-home care program…
Blue Cross and Blue Shield of Louisiana has lost its most recent bid challenging how CMS calculated its 2025 Medicare Advantage star rating. On June 26, the U.S. Court of Appeals for the D.C. Circuit upheld a July 2025 district…
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House Democrats introduced a bill July 1 targeting Medicare Advantage overpayments. Under the bill, HHS would need to exclude or adjust diagnosis codes that “are most likely to be subject to coding variation by Medicare Advantage plans,” limiting possible upcoding.…
Elevance Health is suing CMS over its 2026 Medicare Advantage star ratings, arguing the agency gave competitor Clover Health a favorable recalculation after losing a court case to the insurer in May. In its July 1 complaint filed in the…
The share of Medicare Advantage enrollees in plans that qualified for federal quality bonus payments dropped to 68% in 2026, its lowest point since 2018, according to a KFF analysis published July 1. Five things to know: 1. The drop…
UnitedHealth Group received the largest total Medicare Advantage bonus payments in 2026, pulling in $3.9 billion as total program spending reached $13.4 billion across all MA plans, according to a KFF analysis published July 1. The $13.4 billion in quality…
New Bern, N.C.-based CarolinaEast Medical Center has officially exited Blue Cross Blue Shield of North Carolina’s Medicare Advantage network while extending its participation in UnitedHealthcare’s Medicare Advantage plans through the end of the year. According to a updated payer list…